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Adrenal insufficiency

Unfortunately steroids merely suppress the inflammation while the underlying cause of the disease remains. Another serious concern about steroids is that of toxicity. The abmpt withdrawal of glucocorticoid steroids results in acute adrenal insufficiency. Long term use may induce osteoporosis, peptidic ulcers, the retention of fluid, or an increased susceptibiUty to infections. Because of these problems, steroids are rarely the first line of treatment for any inflammatory condition, and their use in rheumatoid arthritis begins after more conservative therapies have failed. [Pg.388]

Proopiomelanocortin (POMC) is the precursor peptide of hormones and neuropeptides expressed in the pituitary and the hypothalamus (adrenocorticotropic hormone (ACTH), lipotropin, a-melanocyte-stimulating hormone (aMSH), yMSH, 3-endorphin, and others). The main clinical consequences of POMC deficiency are adrenal insufficiency (due to absence of ACTH), red hair pigmentation (due to absence of MSH) and severe early-onset obesity (due to the lack of aMSH). [Pg.1000]

ADRENAL INSUFFICIENCY. Administration of the glucocorticoids poses the threat of adrenal gland insufficiency (particularly if the altemate-day therapy is not prescribed). Administration of glucocorticoids several times a day and during a short time (as little as 5-10 days) results in shutting off the pituitary release of ACTH... [Pg.527]

Potassium is contraindicated in patients who are at risk for experiencing hyperkalemia, such as those with renal failure, oliguria, or azotemia (file presence of nitrogen-containing compounds in the blood), anuria, severe hemolytic reactions, untreated Addison s disease (see Chap. 50), acute dehydration, heat cramps, and any form of hyperkalemia Potassium is used cautiously in patients with renal impairment or adrenal insufficiency, heart disease, metabolic acidosis, or prolonged or severe diarrhea. Concurrent use of potassium with... [Pg.641]

The recent CORTICUS trial (hydrocortisone vs placebo) does not support the routine use of corticosteroids in the management of septic shock. No difference in 28-d mortality was observed between groups, regardless of baseline relative adrenal insufficiency. Duration of shock was shorter in the hydrocortisone group however, an increased incidence of hyperglycemia, sepsis, and recurrent septic shock was observed. This section reflects the 2004 consensus guidelines... [Pg.69]

Hydrocortisone 50 mg IV q6h or 100 mg IV q8h for 7 d in patients with septic shock requiring vasopressor support if relative adrenal insufficiency present... [Pg.69]

If serum cortisol increase is <9 mcg/dL, then patient may have relative adrenal insufficiency... [Pg.69]

Some clinicians advocate a baseline cortisol level <15 mcg/dlV or <25 mcg/dL in critically ill patients as the diagnostic threshold for relative (or functional) adrenal insufficiency... [Pg.69]

Consider adrenal insufficiency ° Manage hyponatremia if present... [Pg.108]

Recognize the clinical presentation of patients with adrenal insufficiency. [Pg.685]

Describe the pharmacologic management of patients with acute and chronic adrenal insufficiency. [Pg.685]

O Signs and symptoms of adrenal insufficiency reflect the disturbance of normal physiologic carbohydrate, fat, and protein homeostasis caused by inadequate cortisol production and inadequate cortisol action. [Pg.685]

Lifelong glucocorticoid replacement therapy may be necessary for patients with adrenal insufficiency, and mineralocor-ticoid replacement therapy usually is required for those with Addison s disease. [Pg.685]

Adrenal insufficiency generally refers to the inability of the adrenal glands to produce adequate amounts of cortisol for normal physiologic functioning or in times of stress. The... [Pg.687]

Autoimmune—accounts for 70%-90% of all cases of primary adrenal insufficiency... [Pg.687]

Bilateral adrenal hemorrhage or infarction—usually due to anticoagulant therapy, coagulopathy, thromboembolic disease, or meningococcal infection. Causes acute adrenal insufficiency. [Pg.687]

Drug-induced (most common cause of secondary adrenal insufficiency)... [Pg.687]

Secondary adrenal insufficiency occurs as a result of a pituitary gland dysfunction whereby decreased production and secretion of ACTH leads to a decrease in cortisol synthesis. Tertiary adrenal insufficiency is a disorder of the hypothalamus that results in decreased production and release of CRH, which, in turn, decreases pituitary ACTH production and release. In contrast to Addison s disease (i.e., primary adrenal insufficiency), aldosterone production is unaffected in the secondary and tertiary forms of the disease. Chronic adrenal insufficiency often has a good prognosis if diagnosed early and treated appropriately. [Pg.688]

Patients with autoimmune adrenal insufficiency may have other autoimmune disorders such as type 1 diabetes mel-litus and autoimmune thyroiditis. [Pg.688]

Salt craving may occur in some patients with primary adrenal insufficiency. [Pg.688]

Dehydration, hypovolemia, and hyperkalemia (in primary adrenal insufficiency only)... [Pg.688]

Hyperpigmentation of skin (usually around creases, pressure areas, areolas, genitalia, and new scars) and mucous membranes. Dark freckles and patches of vitiligo may be present. Hyperpigmentation, owing to increased ACTH levels, occurs in primary adrenal insufficiency. [Pg.688]


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Adrenal disorders insufficiency

Adrenal insufficiency acute

Adrenal insufficiency case study

Adrenal insufficiency chronic disease

Adrenal insufficiency clinical presentation

Adrenal insufficiency corticosteroid-induced

Adrenal insufficiency diagnosis

Adrenal insufficiency disease

Adrenal insufficiency drug-induced

Adrenal insufficiency etiology

Adrenal insufficiency glucocorticoids

Adrenal insufficiency hyperkalemia

Adrenal insufficiency prevention

Adrenal insufficiency primary

Adrenal insufficiency secondary

Adrenal insufficiency systemic glucocorticoids

Adrenal insufficiency tertiary

Adrenal insufficiency treatment

Adrenal insufficiency with corticosteroids

Adrenalectomy adrenal insufficiency

Adrenalitis

Adrene

Betamethasone in adrenal insufficiency

Corticosteroid therapy adrenal insufficiency from

Corticosteroids adrenal insufficiency

Dexamethasone in adrenal insufficiency

Fludrocortisone in adrenal insufficiency

Glucocorticoids adrenal insufficiency with

Hydrocortisone adrenal insufficiency

Hydrocortisone in adrenal insufficiency

Methylprednisolone in adrenal insufficiency

Phenytoin adrenal insufficiency with

Prednisolone in adrenal insufficiency

Prednisone in adrenal insufficiency

Tuberculosis adrenal insufficiency

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